Provider Demographics
NPI:1881723765
Name:COLE, ANDREA E (PHD)
Entity type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:E
Last Name:COLE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 CENTER ST
Mailing Address - Street 2:# 305
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-3062
Mailing Address - Country:US
Mailing Address - Phone:413-587-0728
Mailing Address - Fax:
Practice Address - Street 1:43 CENTER ST
Practice Address - Street 2:# 305
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-3062
Practice Address - Country:US
Practice Address - Phone:413-587-0728
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5090103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
332398OtherMAGELLAN
MA402373OtherTUFTS HEALTH PLAN
W05650OtherBL X BL S
W50723Medicare ID - Type Unspecified